Intake Paperwork

To get started with us, please complete all of the forms found according to the service you are seeking. Once we receive them, we will reach out to get you scheduled or to inform you of your approximate wait time. 

Need assistance completing the forms? Give us a call at 717-761-4754.

 

Occupational and Speech Therapy Forms (Pediatric and Adult):

General Intake Form

Consent to Treatment and Policy Form

Authorization for Release of Information and Consent to Communicate Health Information

Telehealth Consent Form (only needed if telehealth services will be utilized)

 

Counseling Forms (Adults only):

Counseling Intake Form

Informed Consent for Counseling

Telehealth Consent Form (needed for all counseling clients at this time)